Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders Indian Medical PG Practice Questions and MCQs

Question 121: Pyromania is characterized by an irresistible urge to engage in which of the following behaviors?

A. Set objects on fire (Correct Answer)
B. Overeat
C. Excessive sleeping
D. Steal items

Explanation: ***Set objects on fire*** - Pyromania is a **mental disorder** characterized by a powerful, **irresistible urge to start fires**. - The individual experiences **tension or arousal** before the act, followed by **pleasure, gratification, or relief** after setting a fire or witnessing its effects. - This is classified as an **impulse control disorder** in psychiatric nosology. *Overeat* - This behavior is characteristic of **eating disorders** such as **binge eating disorder** or **bulimia nervosa**, not pyromania. - While impulses are involved, the specific urge and gratification are linked to food consumption, not fire-setting. *Excessive sleeping* - **Hypersomnia** or **excessive daytime sleepiness** is a symptom of various sleep disorders or medical conditions, not an impulse control disorder. - There is no direct association between the urge to sleep excessively and the diagnostic criteria for pyromania. *Steal items* - This behavior is characteristic of **kleptomania**, another impulse control disorder. - While both pyromania and kleptomania involve irresistible urges, kleptomania specifically involves stealing objects not needed for personal use or monetary value.

Question 122: What is Trichotillomania?

A. Compulsive hair pulling (Correct Answer)
B. Irresistible desire to set fire to things
C. Irresistible desire to steal
D. Compulsive gambling

Explanation: ***Compulsive hair pulling*** - **Trichotillomania** is characterized by an irresistible urge to **pull out one's own hair**, often leading to noticeable hair loss. - It is classified as an **obsessive-compulsive related disorder** in the DSM-5. *Irresistible desire to set fire to things* - This describes **pyromania**, a distinct impulse control disorder. - While both are impulse control disorders, their specific behaviors and focus are different. *Irresistible desire to steal* - This refers to **kleptomania**, an impulse control disorder characterized by recurrent urges to steal objects not needed for personal use or monetary value. - It is distinct from trichotillomania, which involves self-inflicted harm through hair pulling. *Compulsive gambling* - This is known as **gambling disorder**, an addictive disorder involving persistent and problematic gambling behavior. - It involves financial risk and reward and is not related to hair pulling.

Question 123: An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?

A. Depression
B. OCD
C. Phobia
D. Trichotillomania (Hair-Pulling Disorder) (Correct Answer)

Explanation: ***Trichotillomania (Hair-Pulling Disorder)*** - This condition is characterized by the **recurrent pulling out of one's hair**, resulting in noticeable hair loss or **bald patches**. - The description of a **circumscribed bald patch** without evidence of organic disease in an 18-year-old girl is highly suggestive of trichotillomania, especially given that organic causes of hair loss have been ruled out. *Depression* - While depression can be a **comorbid condition** with trichotillomania, it does not directly cause a circumscribed bald patch. - Depression is a **mood disorder** primarily characterized by persistent sadness, loss of interest, and other emotional and physical symptoms. *OCD* - **Obsessive-compulsive disorder** (OCD) involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - Although trichotillomania can share some characteristics with OCD (e.g., repetitive behavior), it is classified as a distinct **body-focused repetitive behavior disorder** in the DSM-5, not OCD itself. *Phobia* - A phobia is an **anxiety disorder** defined by an intense and irrational fear of a specific object or situation. - Phobias do not directly cause **physical symptoms** like bald patches; their primary manifestation is avoidance and panic in the presence of the feared stimulus.

Question 124: Which personality disorder is most commonly associated with Obsessive-Compulsive Disorder (OCD)?

A. Anankastic Personality Disorder (Correct Answer)
B. Borderline Personality Disorder
C. Narcissistic Personality Disorder
D. Histrionic Personality Disorder

Explanation: ***Anankastic Personality Disorder (Obsessive-Compulsive Personality Disorder)*** - Anankastic Personality Disorder is the **ICD-10 classification** for what is known as **Obsessive-Compulsive Personality Disorder (OCPD)** in the DSM-5. - **Important distinction**: OCD and OCPD are **separate disorders** - OCD is an anxiety disorder with intrusive thoughts and compulsions, while OCPD is a personality disorder characterized by rigid perfectionism and need for control. - OCPD is the **most commonly comorbid personality disorder** with OCD, though most people with OCD do not have OCPD and vice versa. - Individuals with OCPD show a pervasive pattern of **preoccupation with orderliness**, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. *Borderline Personality Disorder* - Characterized by **instability in interpersonal relationships**, self-image, affects, and marked impulsivity. - While it can be comorbid with anxiety disorders, its core features are distinct from the rigid and perfectionistic traits of OCPD. *Narcissistic Personality Disorder* - Involves a pervasive pattern of **grandiosity**, a need for admiration, and a lack of empathy. - These traits are distinct from the compulsive behaviors and perfectionism seen in OCD and OCPD. *Histrionic Personality Disorder* - Defined by a pattern of **excessive emotionality** and attention-seeking behavior. - This presentation is quite different from the rigid, controlling, and overly conscientious nature associated with OCD.

Question 125: What term describes repetitive, intrusive thoughts that cause significant distress or anxiety?

A. Phobia
B. Obsession (Correct Answer)
C. Compulsion
D. Anxiety

Explanation: ***Obsession*** - An **obsession** is defined by the presence of **recurrent and persistent thoughts, urges, or images** that are experienced as intrusive and unwanted, causing significant anxiety or distress. - These thoughts are often recognized as products of one's own mind, and individuals typically attempt to ignore, suppress, or neutralize them. *Phobia* - A **phobia** is an intense, irrational fear of a specific object or situation that poses little or no actual danger. - Unlike obsessions, phobias are typically related to external stimuli and do not primarily involve intrusive thoughts. *Compulsion* - A **compulsion** is a repetitive behavior (e.g., hand washing, checking) or mental act (e.g., praying, counting) that an individual feels driven to perform in response to an obsession. - Compulsions are often aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. *Anxiety* - **Anxiety** is a general term for a feeling of worry, nervousness, or unease, typically about an event or something with an uncertain outcome. - While obsessions cause anxiety, "anxiety" itself is a broad emotional state, not specifically the intrusive thoughts described.

Question 126: A patient presents with compulsive hair pulling resulting in irregular patchy hair loss. What is the most likely diagnosis?

A. Trichotillomania (Correct Answer)
B. Alopecia areata
C. Telogen effluvium
D. Tinea infection

Explanation: ***Trichotillomania*** - This condition is characterized by **recurrent, irresistible urges to pull out hair**, typically resulting in **noticeable hair loss**. - The resulting patchy hair loss is often **irregular** and can occur in various areas, aligning with the patient's presentation. *Alopecia areata* - This is an **autoimmune condition** that causes smooth, **well-demarcated patches of hair loss**, not typically associated with compulsive pulling. - It usually presents with a sudden onset of hair loss without any preceding trauma or manipulation. *Telogen effluvium* - This condition involves **widespread hair thinning** due to a disturbance in the hair growth cycle, often triggered by stress or illness. - It does not involve compulsive hair pulling and typically results in increased hair shedding rather than patchy hair loss. *Tinea infection* - Also known as **ringworm**, this is a fungal infection that can cause **scaly, itchy patches of hair loss**, sometimes with inflammation and broken hairs. - While it can cause patchy hair loss, it is characterized by dermatological signs of infection (e.g., scaling, erythema) and not compulsive hair pulling.

Question 127: Which disorder is characterized by fear of contamination, counting behaviors, and having to check and recheck?

A. Obsessive-compulsive disorder (Correct Answer)
B. Panic disorder
C. Agoraphobia (without panic attacks)
D. Generalized anxiety disorder (GAD)

Explanation: ***Obsessive-compulsive disorder*** - This disorder is precisely characterized by repetitive, intrusive thoughts (obsessions) like **fear of contamination** and repetitive behaviors (compulsions) like **counting** and **checking** performed to reduce anxiety associated with these thoughts. - The individual feels compelled to perform these rituals to prevent a dreaded event or situation, even if they recognize the irrationality of their actions. *Panic disorder* - This disorder involves recurrent, unexpected **panic attacks** that cause intense fear and physical symptoms such as palpitations, shortness of breath, and dizziness. - It does not primarily involve obsessions about contamination or compulsive checking behaviors. *Agoraphobia (without panic attacks)* - This condition involves significant anxiety about being in places or situations from which escape might be difficult or embarrassing, or where help might not be available in case of incapacitating or embarrassing symptoms. - It is often associated with fear of public transportation, open spaces, enclosed places, standing in line, or being in a crowd, and does not typically involve contamination fears or repetitive checking. *Generalized anxiety disorder (GAD)* - GAD is characterized by persistent and excessive worry about a variety of daily life events or activities, such as work, finances, or health. - While it involves chronic anxiety, it does not typically manifest with specific obsessions like contamination or compulsive behaviors such as counting and checking.

Question 128: In which of the following conditions is behavior therapy considered most effective?

A. Panic Attack
B. Psychosis
C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
D. Generalized Anxiety Disorder

Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.

Question 129: What is the treatment of choice for obsessive-compulsive disorder (OCD)?

A. Behavioral therapy focusing on exposure and response prevention.
B. Surgical intervention for treatment-resistant cases.
C. Pharmacological treatment targeting serotonin levels.
D. A combined approach using therapy and medication. (Correct Answer)

Explanation: ***A combined approach using therapy and medication.*** - For **obsessive-compulsive disorder (OCD)**, a combination of **pharmacotherapy** (typically selective serotonin reuptake inhibitors, SSRIs) and **psychotherapy** (**exposure and response prevention**, ERP) is generally considered the most effective first-line treatment approach. - This combined strategy addresses both the neurobiological and behavioral aspects of OCD, leading to better and more sustainable symptom reduction compared to either treatment alone. - Current **APA and NICE guidelines** recommend combined treatment as the **treatment of choice** for moderate to severe OCD. *Behavioral therapy focusing on exposure and response prevention.* - While **Exposure and Response Prevention (ERP)** is the **gold standard psychotherapy** for OCD and is highly effective, it is often best utilized in conjunction with pharmacotherapy, especially for moderate to severe cases. - As a standalone treatment, ERP is effective for mild OCD but may not be sufficient for all patients and may have higher dropout rates if not combined with medication to help manage anxiety. *Surgical intervention for treatment-resistant cases.* - **Surgical interventions**, such as deep brain stimulation (DBS) or cingulotomy, are **reserved for severe, treatment-refractory OCD** that has failed multiple adequate trials of both psychotherapy and pharmacotherapy. - These are highly invasive procedures with significant risks and are not considered a first-line or even second-line treatment choice. *Pharmacological treatment targeting serotonin levels.* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the **first-line pharmacological treatment** for OCD due to their efficacy in modulating serotonin pathways implicated in the disorder. - While effective, medication alone may not fully address the compulsive behaviors and cognitive distortions characteristic of OCD, and its effectiveness is significantly enhanced when combined with ERP.

Question 130: In obsessive-compulsive disorder, which medication is least likely to be prescribed?

A. Haloperidol (Correct Answer)
B. Sertraline
C. Clomipramine
D. Fluoxetine

Explanation: ***Haloperidol*** - **Haloperidol** is a **first-generation antipsychotic** primarily used to treat psychotic disorders like schizophrenia or severe agitation, not OCD as a primary treatment. - Antipsychotics are generally not indicated for OCD unless used as an **adjunctive treatment** in very severe, treatment-resistant cases, or if there's comorbidity with a psychotic disorder. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is a potent serotonin reuptake inhibitor. - It is one of the **oldest and most effective medications** specifically approved for the treatment of OCD. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** and is a first-line treatment for OCD due to its efficacy and favorable side-effect profile. - It is commonly prescribed to increase **serotonin levels** in the brain, which helps reduce obsessive thoughts and compulsive behaviors. *Fluoxetine* - **Fluoxetine** is also an **SSRI** and is a first-line medication for OCD. - It is widely used to manage OCD symptoms by enhancing **serotonergic neurotransmission**.

Practice by Chapter

Obsessive-Compulsive Disorder

Practice Questions

Body Dysmorphic Disorder

Practice Questions

Hoarding Disorder

Practice Questions

Trichotillomania

Practice Questions

Excoriation (Skin-Picking) Disorder

Practice Questions

Tic Disorders

Practice Questions

Tourette's Syndrome

Practice Questions

Pharmacotherapy for OCD and Related Disorders

Practice Questions

Cognitive-Behavioral Therapy for OCD

Practice Questions

Neurosurgical Approaches

Practice Questions

OCD in Children and Adolescents

Practice Questions

OCD Spectrum Disorders

Practice Questions

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